Northeastern University 2015 Medical Benefits

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1 Northeastern University 2015 Medical Benefits

2 Northeastern s 2015 Open Enrollment Effective Date: January 1, Medical Plan Options Blue Choice New England Core POS Plan New Plan Blue Choice New England Enhanced POS Plan New Plan Blue Care Elect Preferred High Deductible PPO Plan with Health Savings Account (HSA) Health Savings Account (HSA) Available to only employees enrolled in high deductible health plan Administered by Health Equity Northeastern University contributes $500 for individual coverage / $1,000 family coverage. Full contribution made in January Visit set-up your on-line Member Central account and take advantage of our discounts, tools & other resources (including Coverage Advisor) No cost preventive care on all plans Dependents covered to age 26 No pre-existing conditions or waiting periods Blue Cross Blue Shield of Massachusetts 2

3 Glossary of Terms Copayment: The fixed amount you pay directly to the provider when you receive some innetwork services. (example: you may see a copayment for office visits or prescription drugs) Deductible: The amount you will pay for certain services before Blue Cross Blue Shield pays out benefits on your behalf. The deductible is based on your calendar year and will reset each January 1st. (example, you may need to meet your deductible if you are having outpatient surgery or diagnostic testing) Coinsurance: The percentage you will be responsible for paying for certain covered medical services. The insurance carrier will pay the higher percentage and you pay the lower percentage. (example, most out-of-network services after your deductible will have ) Out-of-Pocket Maximum: The most you will pay for covered services in a calendar year. Your deductible, co-insurance and all copayments, including pharmacy copayments are calculated to your out-of-pocket maximum. Once you have reached your out-of-pocket maximum, the Blue Cross Blue Shield will then provide 100% coverage for the remainder of the calendar year for covered services. Blue Cross Blue Shield of Massachusetts 3

4 Core POS Plan Enhanced POS Plan Blue Cross Blue Shield of Massachusetts 4

5 Core & Enhanced POS Plans NEW!! Two Levels of Benefit: PCP/Plan Approved Services or Self-Referred PCP / Plan Approved Services: Highest level of benefit with lower out-pocket expenses Use HMO Blue New England network providers six New England States PCP required change anytime Referrals to most network specialists No referrals to network providers: OB/GYN Care Chiropractors Routine Vision Behavioral Health Visits Coverage for Emergency or Out-of-Area Urgent Care world-wide Blue Cross Blue Shield of Massachusetts 5

6 Core & Enhanced POS Plans, continued Self-Referred Benefits: Higher out-of-pocket expenses Use any provider with a payment arrangement with the local BCBS (no benefits will be paid if a payment arrangement is not in place) Benefits are paid based on BCBS s allowed charge and if provider is charging more, then they can balance bill To Find Participating Providers: Visit Call toll-free Physician Selection Service Ask your provider if they re in HMO Blue New England network or have a payment arrangement with BCBS Blue Cross Blue Shield of Massachusetts 6

7 Core & Enhanced Plan In-Network Comparison CORE PLAN PCP/PLAN APPROVED ENHANCED PLAN PCP/PLAN APPROVED BENEFIT YOUR COST YOUR COST DEDUCTIBLE $250 MEMBER / $500 FAMILY NONE OUT-OF-POCKET MAXIMUM $2,500 MEMBER /$5,000 FAMILY $2,000 MEMBER / $4,000 FAMILY PREVENTIVE EXAMS & RELATED TEST NO CHARGE NO CHARGE OFFICE VISITS - PCP $25 COPAY $20 COPAY OFFICE VISITS - SPECIALISTS $35 COPAY $30 COPAY LABS, X-RAYS & OTHER TESTS 10% COINS AFTER DEDUCTIBLE NO CHARGE HIGH TECH IMAGING SERVICES 10% COINS AFTER DEDUCTIBLE $100 HOSPITAL / $0 OTHER PROVIDERS SHORT TERM REHAB - PT, OT & ST $35 COPAY $30 COPAY PROSTHETIC & DME 10% COINS AFTER DEDUCTIBLE NO CHARGE EMERGENCY ROOM $100 COPAY (WAIVED IF ADMITTED) $100 (WAIVED IF ADMITTED) AMBULATORY SURGERY 10% COINS AFTER DEDUCTIBLE NO CHARGE INPATIENT ADMISSION 10% COINS AFTER DEDUCTIBLE NO CHARGE PRESCRIPTION DRUGS RETAIL - 30 DAY SUPPLY $5/$30/$50 $5/$30/$50 MAIL SERVICE - 90 DAY SUPPLY $10/$60/$100 $10/$60/$100 (Refer to benefit literature for out-of-network benefits) Blue Cross Blue Shield of Massachusetts 7

8 High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Blue Cross Blue Shield of Massachusetts 8

9 HDHP with HSA PPO Platform: This means: Choose any doctor or hospital No primary care physician (PCP) or referrals required Two Levels of Benefit: In-Network or Out-of-Network - where you choose to go determines benefit level In-Network benefits: Highest level of benefit with lower out-pocket expenses Use a BCBS National PPO Preferred Provider or use emergency room Out-of-Network: Higher out-of-pocket expenses Use any licensed provider Out-of-network providers may balance bill if they charge more than BCBS's allowed reimbursement Blue Cross Blue Shield of Massachusetts 9

10 HDHP with HSA To Find Participating Providers Visit Call toll-free Physician Selection Service Ask your provider if they re in BCBS PPO national network Blue Cross Blue Shield of Massachusetts 10

11 HDHP with HSA IN-NETWORK BLUE CARE ELECT PPO - HDHP OUT-OF-NETWORK BENEFIT YOUR COST YOUR COST DEDUCTIBLE OUT-OF-POCKET MAXIMUM $1,500 IND/$3,000 FAMILY CONTRACT $2,500 IND/$5,000 FAMILY CONTRACT $2,500 IND/$5,000 FAMILY CONTRACT $4,000 IND/$8,000 FAMILY CONTRACT PREVENTIVE EXAMS & RELATED TEST NOTHING (NO DEDUCTIBLE) 20% COINS (NO DEDUCTIBLE) OFFICE VISITS - PCP 10% COINS * 30% COINS * OFFICE VISITS - SPECIALIST 10% COINS * 30% COINS * LABS, X-RAYS & OTHER TESTS 10% COINS * 30% COINS * HIGH TECH IMAGING SERVICES 10% COINS * 30% COINS * PROSTHETIC & DME 10% COINS * 30% COINS * EMERGENCY ROOM 10% COINS * AMBULATORY SURGERY 10% COINS * 30% COINS * INPATIENT ADMISSION 10% COINS * 30% COINS * PRESCRIPTION DRUGS RETAIL - 30 DAY SUPPLY $5/$30/$60 * $10/$60/$100 * MAIL SERVICE - 90 DAY SUPPLY $10/$60/$100 * NOT COVERED * AFTER DEDUCTIBLE Blue Cross Blue Shield of Massachusetts 11

12 Health Savings Account (HSA) A Health Savings Account (HSA) is a tax-advantaged personal savings account that works With a HSA-compatible health plan, such as Northeastern s HDHP Use it to pay for qualified medical, dental & vision expenses with tax-free dollars Deposits to account are tax free based on IRS guidelines for contribution limits The accountholder owns it; account stays with you even if you switch plans or leave employer No use-it-or-lose-it requirement; balance plus earning carries over year to year tax free Investments & interest on account are tax free Eligibility requirements based on IRS guidelines Administration of HSA portion of plan is through a BCBSMA partner, Health Equity Northeastern contributes $500 individual contract /$1,000 family contract New for 2015: Full contribution made in January! Blue Cross Blue Shield of Massachusetts 12

13 Member Cost Share Type by Plan 2015 Northeastern Medical Plans Type of care Enhanced Core HDHP with HSA Routine exams for preventive care including immunizations and routine vision exams no charge no charge no charge Office visits for non-preventive care (PCP and specialist) copay copay Rehabilitation, speech, occupational, chiropractic and physical therapy copay copay Outpatient mental health services copay copay Urgent Care / Emergency room care copay copay Non-preventive labs, tests and x-rays High tech radiology (CT, PET, MRI) Outpatient surgery Inpatient hospitalization (e.g. acute care, maternity, rehabilitation, mental health) no charge no charge or copay in hospital setting no charge no charge Prescriptions copay copay copay Note: Reflects in-network/pcp-referred benefits only Blue Cross Blue Shield of Massachusetts 13

14 Blue Cross Member Support Tools Blue Cross Blue Shield of Massachusetts 14

15 Blue Cross Mobile Services Blue Cross Blue Shield of Massachusetts 15

16 Questions? Call Member Service toll-free number on ID card: Monday - Friday, 8am - 8pm (Eastern Standard Time) Visit Blue Cross Blue Shield of Massachusetts 16

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